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Plate # 0-Composite
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tory of severe allergic reactions (intensity of reactions may beq); OB, Lactation,
Pedi: Safety not established; crosses the placenta and may cause fetal/neonatal
bradycardia, hypotension, hypoglycemia, or respiratory depression; Geri:qsensitivity to beta blockers; initial dosageprecommended.
bisoprolol (bis-oh-proe-lol)
Zebeta
Classification
Therapeutic: antihypertensives
Pharmacologic: beta blockers
Pregnancy Category C
Adverse Reactions/Side Effects
CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares. EENT: blurred vision,
stuffy nose. Resp: bronchospasm, wheezing. CV: BRADYCARDIA, HF, PULMONARY
EDEMA, hypotension, peripheral vasoconstriction. GI: constipation, diarrhea,qliver
function tests, nausea, vomiting. GU: erectile dysfunction,p libido, urinary frequency. Derm: rash. Endo: hyperglycemia, hypoglycemia. MS: arthralgia, back
pain, joint pain. Misc: drug-induced lupus syndrome.
Indications
Management of hypertension.
Action
Blocks stimulation of beta1(myocardial)-adrenergic receptors. Does not usually affect beta2(pulmonary, vascular, uterine)-receptor sites. Therapeutic Effects:
Decreased BP and heart rate.
Pharmacokinetics
Absorption: Well absorbed after oral administration, but 20% undergoes firstpass hepatic metabolism.
Distribution: Unknown.
Metabolism and Excretion: 50% excreted unchanged by the kidneys; remainder renally excreted as metabolites; 2% excreted in feces.
Half-life: 9– 12 hr.
TIME/ACTION PROFILE (antihypertensive effect)
ROUTE
ONSET
PEAK
DURATION
PO
unknown
1–4 hr
24 hr
Interactions
Drug-Drug: General anesthetics, IV phenytoin, and verapamil may cause additive myocardial depression. Additive bradycardia may occur with digoxin, diltiazem, verapamil, or clonidine. Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates. Concurrent use with
amphetamine, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia). Concurrent thyroid preparation administration may p effectiveness. May alter the effectiveness of insulins or oral
hypoglycemic agents (dose adjustments may be necessary). Maypthe effectiveness of theophylline. Maypthe beta1-cardiovascular effects of dopamine or dobutamine. Use cautiously within 14 days of MAO inhibitor therapy (may result in
hypertension).
Route/Dosage
Contraindications/Precautions
Contraindicated in: Uncompensated HF; Pulmonary edema; Cardiogenic shock;
PO (Adults): 5 mg once daily, may beqto 10 mg once daily (range 2.5– 20 mg/
day).
Bradycardia or heart block.
Use Cautiously in: Renal impairment (dosageprecommended); Hepatic impairment (dosageprecommended); Pulmonary disease (including asthma; beta1 selectivity may be lost at higher doses); avoid use if possible; Diabetes mellitus (may mask
signs of hypoglycemia); Thyrotoxicosis (may mask symptoms); Patients with a his-
Renal Impairment
⫽ Canadian drug name.
⫽ Genetic Implication.
Hepatic Impairment
PO (Adults): CCr ⬍40 mL/min— Initiate therapy with 2.5 mg/day, titrate cautiously.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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NURSING IMPLICATIONS
Assessment
Plate # 0-Composite
● Caution patient that this medication may increase sensitivity to cold.
● Instruct patient to notify health care professional of all Rx or OTC medications, vi-
● Monitor BP, ECG, and pulse frequently during dosage adjustment period
and periodically throughout therapy.
● Monitor intake and output ratios and daily weights. Assess routinely for
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signs and symptoms of HF (dyspnea, rales/crackles, weight gain, peripheral
edema, jugular venous distention).
Monitor frequency of prescription refills to determine adherence.
Lab Test Considerations: May cause increased BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels.
May cause increased ANA titers.
May cause increase in blood glucose levels.
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Potential Nursing Diagnoses
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Decreased cardiac output (Side Effects)
Noncompliance (Patient/Family Teaching)
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Implementation
● Do not confuse Zebeta with Diabeta or Zetia.
● PO: Take apical pulse before administering. If ⬍50 bpm or if arrhythmia occurs,
withhold medication and notify physician or other health care professional.
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tamins, or herbal products being taken and to consult health care professional before taking any Rx, OTC, or herbal products, especially cold preparations, concurrently with this medication. Patients on antihypertensive therapy should also avoid
excessive amounts of coffee, tea, and cola.
Diabetics should closely monitor blood glucose, especially if weakness, malaise,
irritability, or fatigue occurs. Medication does not block dizziness or sweating as
signs of hypoglycemia.
Advise patient to notify health care professional if slow pulse, difficulty
breathing, wheezing, cold hands and feet, dizziness, light-headedness,
confusion, depression, rash, fever, sore throat, unusual bleeding, or
bruising occurs.
Instruct patient to inform health care professional of medication regimen before
treatment or surgery.
Advise patient to carry identification describing disease process and medication
regimen at all times.
Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Medication controls but
does not cure hypertension.
Evaluation/Desired Outcomes
● May be administered without regard to meals.
● Decrease in BP.
Patient/Family Teaching
Why was this drug prescribed for your patient?
● Instruct patient to take medication exactly as directed, at the same time each day,
even if feeling well; do not skip or double up on missed doses. If a dose is missed,
it should be taken as soon as possible up to 4 hr before next dose. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or
myocardial ischemia.
● Teach patient and family how to check pulse and BP. Instruct them to check pulse
daily and BP biweekly and to report significant changes to health care professional.
● May cause drowsiness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known.
● Advise patients to change positions slowly to minimize orthostatic hypotension.
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